title: Start-up and incremental practice expenses for behavior change interventions in primary care.
abstract: BACKGROUND
  If behavior-change services are to be offered routinely in primary care practices, providers must be appropriately compensated. Estimating what is spent by practices in providing such services is a critical component of establishing appropriate payment and was the objective of this study.
  
  
  METHODS
  In-practice expenditure data were collected for ten different interventions, using a standardized instrument in 29 practices nested in ten practice-based research networks across the U.S. during 2006-2007. The data were analyzed using standard templates to create credible estimates of the expenses incurred for both the start-up period and the implementation phase of the interventions.
  
  
  RESULTS
  Average monthly start-up expenses were $1860 per practice (SE=$455). Most start-up expenditures were for staff training. Average monthly incremental costs were $58 ($15 for provision of direct care [SE=$5]; $43 in overhead [SE=$17]) per patient participant. The bulk of the intervention expenditures was spent on the recruitment and screening of patient participants.
  
  
  CONCLUSIONS
  Primary care practices must spend money to address their patients' unhealthy behaviors--at least $1860 to initiate systematic approaches and $58 monthly per participating patient to implement the approaches routinely. Until primary care payment systems incorporate these expenses, it is unlikely that these services will be readily available.
authors.affiliation: The Robert Graham Center, Washington, DC 20036, USA. mdodoo@aafp.org
authors.forename: Martey S
authors.initials: MS
authors.lastname: Dodoo
authors.forename: Alex H
authors.initials: AH
authors.lastname: Krist
authors.forename: Maribel
authors.initials: M
authors.lastname: Cifuentes
authors.forename: Larry A
authors.initials: LA
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D015438:Health Behavior; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D018579:Patient Selection; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D014481:United States; D055815:Young Adult